Glycemic Control In Diabetic Patients Research Articles

Commutable whole blood reference materials for hemoglobin A1c validated on multiple clinical analyzers.

Background The measurement of hemoglobin A1c (HbA1c) is important for diagnosing diabetes mellitus as well as assessing glycemic control in diabetic patients. Commutable whole blood certified reference materials (CRMs) are needed in the measurement of HbA1c for method validation and/or as quality controls. Methods We developed three levels of hemolyzed whole blood CRMs for HbA1c. The certified values were determined using liquid chromatography-isotope dilution tandem mass spectrometry method (LC-IDMS/MS) where two "signature" hexapeptides of HbA1c and hemoglobin A0 (HbA0) were used as the calibration standards. The concentrations of the hexapeptide solutions were determined by amino acid analysis by the LC-IDMS/MS method using amino acid CRMs as the calibration standards. The commutability study was conducted by measuring 25 patient specimens and the whole blood CRMs by both LC-IDMS/MS method and various routine methods using six different clinical analyzers. Results The certified values were determined to be 35.1±2.0, 50.3±1.9 and 65.8±2.6 mmol/mol, respectively. These CRMs showed good commutability on five of the six clinical analyzers but showed poor commutability on one of the clinical analyzers that used similar method as two other analyzers where good commutability was observed. Conclusions With certified target values based on metrological traceability and good commutability on most of the clinical analyzers, the developed whole blood CRMs can be used for method validation or as quality control materials in the measurement of HbA1c. The commutability study results also underscored the need of commutability testing of clinical CRMs using various clinical analyzers.

Altered Glycemic Control Associated With Polymorphisms in the SLC22A1 (OCT1) Gene in a Mexican Population With Type 2 Diabetes Mellitus Treated With Metformin: A Cohort Study

The organic cation transporters OCT1 and OCT2 and the multidrug and toxin extrusion transporter MATE1, encoded by the SLC22A1, SLC22A2, and SLC47A1 genes, respectively, are responsible for the absorption of metformin in enterocytes, hepatocytes, and kidney cells. The aim of this study was to evaluate whether genetic variations in the SLC22A1, SLC22A2, and SLC47A1 genes could be associated with an altered response to metformin in patients with type 2 diabetes mellitus. A cohort study was conducted in 308 individuals with a diagnosis of type 2 diabetes mellitus of less than 3years and who had metformin monotherapy. Three measurements of blood glycated hemoglobin (HbA1c ) were obtained at the beginning of the study and after 6 and 12months. Five polymorphisms were analyzed in the SLC22A1 (rs622342, rs628031, rs594709), SLC22A2 (rs316019), and SLC47A1 (rs2289669) genes by real-time polymerase chain reaction. The results showed a significant association among genotypes CC-rs622342 (β = 1.36; P < .001), AA-rs628031 (β = 0.98; P = .032), and GG-rs594709 (β = 1.21; P = .016) in the SLC22A1 gene with an increase in HbA1c levels during the follow-up period. Additionally, a significant association was found in the CGA and CAG haplotypes with an increase in HbA1c levels compared to the highest-frequency haplotype (AGA). In conclusion, the genetic variation in the SLC22A1 gene was significantly related to the variation of the HbA1c levels, an important indicator of glycemic control in diabetic patients. This information may contribute to identifying patients with an altered response to metformin before starting their therapy.

Control glucémico de pacientes diabéticos en dos Unidades de Salud Familiar, Paraguay, 2018. Estudio piloto

Introduccion: la diabetes mellitus (DM) es una enfermedad prevalente en el Paraguay y el tratamiento adecuado exige un control glucemico estricto. Objetivos: determinar la frecuencia de control glucemico adecuado en diabeticos de tres Unidades de Salud Familiar de Aregua, Paraguay. Metodologia: diseno observacional, prospectivo que incluyo a varones y mujeres adultos, portadores de DM en tres Unidades de Salud Familiar de Aregua y Asuncion, Paraguay, en 2018. Se midieron variables antropometricas, clinicas y laboratoriales. La glucemia en ayunas fue obtenida por glucometro. Resultados: se incluyo a 111 diabeticos, 97% de tipo 2. La edad media fue 62±9 anos y predomino el sexo femenino (70%). La frecuencia de diabeticos con hemoglobina glicada <7% fue 56%. La preobesidad y obesidad juntas se observaron en 71%. La comorbilidad mas frecuente fue la hipertension arterial (87%). El mal control glucemico se asocio significativamente al sedentarismo y bajo ingreso economico. Conclusiones: el control glucemico adecuado determinado por la hemoglobina glicada fue 56%. Se requieren estudios en mayores muestras para determinar las causas de falta de control glucemico en los diabeticos de las Unidades de Salud Familiar.

Diabetic patients in Saudi Arabia: The evaluation of glycemic control measures based on emergency department utilization and the percentages of adherence to the recommended follow-ups for microvascular complications.

Objectives:To determine the association between emergency department (ED) visits, glycemic control and the quality of preventive diabetes care among diabetic patients in a Saudi community.Methods:This study was an observational, cross-sectional study that collected data through interview-based surveys between February and April 2017. Data were collected from 530 diabetic patients in the diabetes clinics at King Saud Medical City, the tertiary center of Riyadh, Kingdom of Saudi Arabia.Results:This study found statistically significant relationships (p<0.05) between ED visits and patient age, the glycated hemoglobin (HbA1c) and education level. Emergency department visits increased by 43% for each unit of increase in HbA1c (odds ratio [OR]=1.43, 95% confidence interval (CI)=1.26-1.62). Graduating from high school decreased the odds of visiting the ED by 43% (OR=0.57, 95% CI=0.34-0.94). Most of the participants were not followed for possible microvascular complications; the majority did not visit nephrology (96.2%), ophthalmology (78.3%) and neurology (97.9%) clinics within the 12 months prior to the interviews.Conclusion:Emergency department visits can indicate poor glycemic control in diabetic patients. Additionally, the current practices of preventive diabetes care in Saudi Arabia are not sufficient, according to the diabetic standards of care recommended by the American Diabetes Association.

Chorea, Hyperglycemia, Basal Ganglia Syndrome in Diabetes – Two Rare Case Reports

Neurological manifestations of diabetes are protean. Hyperglycaemia induced involuntary movements (HIIM) are uncommon manifestations of diabetes seen especially in those with poor glycaemic control. Of these, basal ganglia syndrome (C-H-BG) is a rare entity which can mislead the unwary. Awareness and prompt recognition of C-H-BG syndrome is crucial, since correction of hyperglycaemia can lead to favourable clinical and radiological improvement. In this article, we report two patients presenting with C-H-BG syndrome on a background of poor glycaemic control. The clinical features of these two elderly diabetic females were characterized by hemichorea-hemiballismus in the first patient and generalised bilateral chorea/ballism in the second one. Radiologic findings associated with C-H-BG syndrome were characterized by hyperattenuation and hyperintensity on T1-weighted magnetic resonance imaging (MRI) at bilateral basal ganglion regions in both cases. Strict glycaemic control formed the corner stone of treatment for the two cases. The prognosis of nonketotic hyperglycemia-induced hemichorea-hemiballism is good and depends on the prompt recognition and optimal glycaemic control in diabetic patients.

The MTHFR promoter hypermethylation pattern associated with the A1298C polymorphism influences lipid parameters and glycemic control in diabetic patients

BackgroundPolymorphisms in the gene encoding methylenetetrahydrofolate reductase (MTHFR) have been investigated as risk factors for microvascular complications of diabetes; however, simultaneous analysis of these polymorphisms and the methylation pattern of the gene has never been conducted. The objective of the present study was to evaluate the simultaneous relationship between MTHFR methylation and MTHFR C6TT7 and A1298C polymorphisms with metabolic, inflammatory and oxidative stress parameters related to microvascular complications, diabetic retinopathy (DR) and diabetic nephropathy (DN) in diabetic patients.MethodsA total of 107 patients who were diagnosed in the previous 5 to 10 years were recruited and divided into groups with complications (DR and/or DN) or without complications. Methylation analysis of the gene promoter was conducted using the MSP technique, and analysis of the A1298C and C677T polymorphisms was conducted using the restriction fragment length polymorphism (RFLP) assay. Microalbuminuria was determined using urine samples, and other analytes of interest were determined in blood samples using commercial kits. The Mann–Whitney and Chi square statistical tests were used with significance considered at p < 0.05.ResultsSubjects with a hypermethylated profile and the 1298AA genotype showed the highest levels of blood glucose (p = 0.03), total cholesterol (p = 0.0001) and LDL cholesterol (p = 0.0006). The same profile was associated with higher levels of HbA1c (p = 0.025), glycemia (p = 0.04) and total cholesterol (0.004) in the control group and total cholesterol (p = 0.005) and LDL cholesterol (p = 0.002) in the complications group. Serum creatinine was higher in subjects in the hypermethylated group with the genotype 677CC only in the control group (p = 0.0020). The methylated profile in presence of 677CC + 1298AA and the 677CT/TT +1298AA haplotypes showed higher levels of total cholesterol (p = 0.0024; 0.0031) and LDL cholesterol (p = 0.0060; 0.0125) than 1298AC/CC carriers. The fasting glycemia was higher in hypermethylated profile in the presence of 677CC/1298AA haplotype (p = 0.0077).ConclusionThe hypermethylated methylation profile associated with the 1298AA genotype appeared to be connected to higher values of glycemia, total cholesterol and LDL cholesterol.

A Prospective Multicentric Postmarketing Observational Study to Characterize the Patient Population with Reduced Gastrointestinal Motility among Indian Diabetic Patients Receiving Itopride: The Progress Study.

Aims:This study was intended to assess the clinical profile of Indian diabetic patients with reduced gastrointestinal (GI) motility and to understand the role of itopride in addressing reduced GI motility (gastroparesis) symptoms and maintaining glycemic control.Material and Methods:Patients with established reduced GI motility (scintigraphy), with varying degree of GI symptoms, receiving itopride 150 mg as per physicians' discretion were enrolled. Clinical profile, changes in symptom severity, glycemic indices, tolerability, and quality of life (QoL) after 8-week therapy (Patient assessment of upper GI disorders-QoL [PAGI-QoL]) were assessed.Results:Mean ± standard deviation age of enrolled population (n = 41) was 51.8 ± 12.39 years. Average duration of gastroparesis since underlying etiology was 67.7 ± 59.76 months. Common symptoms reported at baseline were bloating (68.3%), postprandial fullness (61.0%), nausea (51.2%), early satiety (41.5%), heartburn (39.0%), and vomiting (9.8%). Itopride therapy resulted in significant improvement in all symptoms (P < 0.001), which correlated with improved QoL (PAGI-QoL score reduction: 13.8 ± 11.48; P < 0.0001). Moreover, significant improvement in glycemic indicators was also evident (mean change from baseline hemoglobinA1c –0.5 ± 1.18; fasting plasma glucose –15.3 ± 43.61; postprandial plasma glucose –24.6 ± 57.20).Conclusions:Itopride showed effectiveness in addressing symptoms of reduced GI motility in diabetics, with improved QoL. Significant improvement in glycemic indices was also evident posttreatment with itopride. This study sheds light on the role of prokinetics, not only for symptom relief but also for improving glycemic control in diabetic patients with reduced GI motility, thus providing a holistic approach for the management of these patients.

Glycated albumin level is significantly decreased in patients suffering nephrotic syndrome.

Serum glycated albumin (GA) level is used along with that of glucose and glycated hemoglobin (HbA1c) as indicators of glycemic control for diabetic patients. Although serum GA levels are affected by blood glucose level, they are also influenced by serum albumin metabolism and other pathological conditions. However, a systematic comparison of the serum GA levels in different types of human diseases has not been reported. In current study, 86,319 clinical lab test results of GA levels from healthy individuals and patients with 57 different types of diseases during the past 5 years in our hospital were retrieved and analyzed. Based on the mean (SD), median, and p (-Log10p) values, we found 29/57 diseases including type 2 diabetes, diabetic nephropathy, uremia, pancreatic cancer, liver cancer, hepatic encephalopathy, and azotemia had significantly (p<0.05, -Log10p>1.30) increased GA levels whereas 18/57 diseases including nephrotic syndrome, preeclampsia, Wilms' tumor, lupus erythematosus, and sepsis had significantly decreased GA levels compared to that of healthy controls. Moreover, the highest -Log10p values (>100) were observed in nephrotic syndrome, type 2 diabetes, preeclampsia, coronary heart disease, uremia, acute cerebral infarction, leukemia, and cerebrovascular disease in a descending order. These data indicated that the serum GA levels could be increased or decreased significantly in a disease-specific manner. Revealing the molecular mechanisms underlying these observations might make the increased or decreased serum GA levels indicators for different types of diseases, especially as an indicator that distinguishes nephrotic syndrome from other types of kidney diseases.

Effect of Non-Surgical Periodontal Therapy on the Serum Sialic Acid Levels in Diabetic Patients with Periodontitis.

Sialic acid (SA), a family of acetylated derivatives of neuraminic acid, an acute phase reactant by itself. It usually occurs as a terminal component at the non-reducing end of carbohydrate chains of glycoproteins and glycolipids. SA participates in multiple physiological functions, such as cell-to-cell interactions, cell migration and proliferation. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by rise in blood glucose level. Periodontitis is a chronic inflammatory disease of the periodontal tissue, leading to destruction of bone surrounding the tooth and ultimately tooth loss. There is a two way relationship between diabetes mellitus and periodontitis. Periodontitis is the sixth complication of diabetes along with retinopathy, nephropathy, neuropathy, macrovascular disease, and altered wound healing. Inflammatory mediators like interleukin-6 and tumor necrosis factor-alpha produced during periodontal inflammation can interfere with the actions of insulin receptors and worsen the glycemic control of diabetic patients. Periodontitis is a major cause of tooth loss, affecting over 300 million people and bacteria associated with periodontitis are also linked with systemic problems like endocarditis, atherosclerosis. Recent work has highlighted a major role for the host sugar sialic acid in the biofilm physiology and host-pathogen interactions of T. forsithya, a key periodontal pathogen. There exists a need for a biomarker, for early detection of disease evolution and more robust therapy efficacy measurements. Serum sialic acids were estimated in Indian population by diphenylamine method and Thiobarbituric acid method. The average values were 68 ± 2.6 mg percent by DPA method and 56 ± 5 mg percent by TBA (thiobarbituric acid assay) method. Age and sex showed no influence on serum sialic acid level. Objectives of the present study was to compare (TSSA) level in healthy subjects, subjects with (CMP) with and without (NIDDM) and its effect on non-surgical periodontal therapy. In the present study, the participants were divided into three groups: Group A, B and C. Group A consists of systemically healthy subjects, Group B consists of subjects with (CMP) while Group C consists of subjects with (CMP) with (NIDDM) and results of this study indicated that, at baseline, there were significant differences between Group A, B and Group C with respect to all the clinical parameters, including (GI), (OHI-S), (PPD), (CAL), (TSSA) and (HbA1c) levels. Thus (TSSA) level could be considered as novel biomarker in the progression of periodontal disease and diabetic status. Periodontitis could be considered as a potential, modifiable, and independent risk factor for the development of diabetes. Early detection of elevated (TSSA) level may help in interpreting the progression of periodontitis, risk of development of diabetes mellitus in future and also to prevent complications.

Relationships between the diabetes awareness and clinical indices/nutrient intakes in Korean adults: Based on the 2012-2013 Korea National Health and Nutrition Examination Survey Data.

BACKGROUND/OBJECTIVESDiabetes is diagnosed after an average of 10–12 years of diabetic development. Strict glycemic control in diabetic patients promotes the normalization of blood glucose and reduces cardiovascular diseases (CVDs) and diabetic complications. Therefore, early diagnosis in non-aware individuals is very important.SUBJECTS/METHODSClinical indices and nutrient intakes in Korean diabetic adults aged 19–64 years were examined according to the awareness of diabetes, using 2012 and 2013 Korea National Health and Nutrition Examination Survey (KNHANES) data. The aware group was defined as individuals who were aware of having diabetes from diagnosis by physician before the survey and the non-aware group as individuals who were not aware of having diabetes.RESULTSThe average age was higher in the aware group compared to the non-aware group in both men (P = 0.002) and women (P = 0.004). The prevalences of hypertension and dyslipidemia were not different between the two groups, but the diagnosis rate was significantly lower in the non-aware group. In the non-aware group, total and LDL-cholesterol were significantly higher (P < 0.001), the risk for total cholesterol over 240 mg/dL was 3.4 times (95% CI: 1.58–7.52) higher (P = 0.002) and the risk for LDL-cholesterol over 160 mg/dL was 4.59 times (95% CI: 2.07–10.17) higher (P < 0.001). The calorie intake of the female non-aware group was significantly higher compared to the female aware group (P = 0.033).CONCLUSIONThe results suggested that the recommendation of screening test is necessary even for young adults. Studies on the methodology for early diagnosis of diabetes are also needed.

Glycated serum proteins: High in pancreatic cancer and low in preeclampsia.

Glycated serum protein (GSP, measured as serum fructosamine concentration in μmol/L) is a product of glycation reaction between glucose and serum proteins in the blood circulation. GSP is used along with blood glucose, glycated hemoglobin (HbA1c), and glycated albumin as indicators of glycemic control for diabetic patients. However, a systematic comparison of the GSP levels in different types of human diseases has not been reported. In this study, 62,698 clinical lab test results of GSP levels in patients with 61 clinically defined diseases over the past 5 years in our hospital were retrieved and compared to that of 1861 clinical lab test results in healthy individuals. Based on the mean (SD), median, and p (-Log10p) values, we found that patients with type 2 diabetes, hepatic encephalopathy, pancreatic cancer, healthy individuals >65 years old, and cerebral arteriosclerosis had significantly (p<0.05, -Log10p>1.30) increased whereas patients with 49/61 diseases including preeclampsia, nephrotic syndrome, sepsis, lupus erythematous, and leukemia had significantly decreased GSP levels compared to that of healthy controls. Among the 61 diseases, type 2 diabetes and leukemia had the highest -Log10p values (>274) and lupus erythematous, nephrotic syndrome, and gastric cancer had -Log10p values >140. Revealing the molecular mechanisms especially those underlying the decreased GSP levels in most of human diseases might make GSP levels serve more clinical purposes in future.

Relationship between Hemoglobin A1c Level and Severity of Coronary Artery Disease Among The Hospitalized Patients with Acute Coronary Syndrome

Background : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS.&#x0D; Materials &amp; Methods : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c&gt;6.5%) and rest of were nondiabetics (HbA1c&lt;6.5%) ( group-A and B).&#x0D; Results: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p&gt;.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289).&#x0D; Conclusions: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients.&#x0D; Bangladesh Heart Journal 2018; 33(2) : 80-84

Glycemic Status and Mortality in Chronic Kidney Disease According to Transition Versus Nontransition to Dialysis

The impact of glycemic control in diabetic patients with chronic kidney disease (CKD) who may or may not transition to dialysis remains uncertain, given recent interest in the conservative management of advanced CKD without dialysis therapy, which may benefit from alternative glycemic control strategies. Among a national cohort of US Veterans, we examined the association of glycemic status, defined by averaged random blood glucose and hemoglobin A1c (HbA1c), with mortality after transitioning to dialysis over 2007-2011 (Transition Cohort) compared with patients in a one-to-one matched cohort of CKD patients with diabetes who did not transition to dialysis (Nontransition Cohort). Among 17,121 patients in the Transition Cohort, averaged random glucose ≥200mg/dL was associated with higher mortality in expanded case-mix analyses (reference: 100-<120mg/dL): adjusted hazard ratio (95% confidence interval) 1.26 (1.13-1.40). In the transition cohort, HbA1c 8-<10% and ≥10% were associated with higher mortality (reference: 6-<8%): adjusted hazard ratios (95% confidence interval) 1.21 (1.11-1.33) and 1.43 (1.21-1.69), respectively. Among 8,711 patients in the Nontransition Cohort, averaged random glucose <100mg/dl and ≥160mg/dl were associated with higher death risk, whereas HbA1c was not associated with mortality. In diabetic CKD patients transitioning to dialysis, higher averaged random glucose and HbA1c were associated with early dialysis mortality, whereas in matched CKD patients who did not transition, both lower and higher glucose levels were associated with higher mortality. These data suggest the need for different glycemic strategies based on whether there are plans to transition to dialysis versus pursue conservative management among diabetic patients with CKD.

Association between Social Jetlag and glycemic control in diabetic patients at King Saud University Medical City

Introduction Social Jetlag has been linked to many cardiovascular and metabolic diseases, as it disturbs the circadian rhythm. Methodology case-control matched by age and gender conducted among 511 subjects. Control group: Diabetic with HbA1c Results Social Jetlag status was similar among both cases and control participants which indicate that there was no significant association between Social Jetlag and HbA1c (P-value = 0.394). The prevalence of Social Jetlag in the studied population is 58.4%. Conclusion We suggest future studies to have a more precise estimation of sleep duration and Social Jetlag and focusing on Social Jetlag and its related problems.

Sample of Aboriginal Australians, 2-hour post-load insulin concentrations are greatest between fasting plasma glucose values of 6.7-7.3 mmol/l

Background: Prevention of diabetic complications requires good glycaemic control. This study aimed to provide type 2 diabetes patients with remote active care and glycaemic control through the use of videophone technology without the need for them to attend hospital. The literature recommends additional research to study the impact of technical innovations on improved disease self-management and medical outcome. This is the only study to be conducted in Turkey concerning patient monitoring using videophone technology. The aim of the study was to establish the effectiveness of the use of videophone technology in the glycaemic control of patients with diabetes living in remote areas. Methods: This is a prospective, randomized control study using the systematic sampling method (using half ratio), in which 24 patients were chosen for the Experimental Group (EG) and another 24 for the Control Group (CG). All of the patients agreed to participate in the study. Patients in the CG received routine care, while the glycaemic control and consultations for patients in the EG were conducted using videophone technology. The patients were monitored by videophone for a total of 6 months. The HbA1c and blood glucose values recorded over the 6 month monitoring period were analyzed to determine the effectiveness of using a videophone. Results: The mean age of the individuals in the EG was 54.41 ± 8.54 years (Min=43 Max=78) and in the CG it was 57.25 ± 9.61 (Min=40 Max=77). In both groups, 50% of the individuals were men and 50% were women. When the two groups were compared, it was was found that the preprandial blood glucose levels of the diabetic patients in the EG (mean 159.48 ± 40.71mg/dl) were lower by 13.55 ± 52.89 mg / dl than the preprandial blood glucose levels of the diabetic patients in the CG (mean 173.03 ± 65.07 mg/dl). It was determined at the end of the six-month monitoring that the A1c levels of the individuals in the EG were significinatly lowered by 0.49% in total, and that the A1c levels of the individuals in the CG were higher by 0.17 % in total. Conclusions: It was shown that videophone technology can be useful in the glycaemic control of diabetic patients in Turkey.

GLYCEMIC INDEX OF PRE-EXERCISE MEAL IN DIABETES MELLITUS: A SYSTEMATIC REVIEW

ABSTRACT Physical exercise and diet quality are essential for glycemic control of diabetic patients, but consideration must be given to the risk of hypoglycemia in response to exercise. Therefore this study aims at 1) conducting a systematic review of the glycemic index (GI) of the pre-exercise meal and of glycemic behavior during and after aerobic exercise in diabetic subjects, and 2) discussing the safest and most appropriate pre-exercise nutritional guidance for this population. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), two researchers independently undertook a systematic search. A third researcher participated in the selection of articles due to the presence of discrepancies. We selected two studies which both suggest that a low glycemic index (GI) meal is the best pre-exercise option, one of which suggests that the optimal time for food intake is 30 minutes before exercise. However, these results are not sufficient to define a clinical conduct, and other studies are needed to elucidate whether GI is a relevant parameter for pre- and post-exercise clinical monitoring of patients with diabetes mellitus (DM), particularly as regards to the different guidelines for type 1 and type 2 DM. Level of Evidence II; Prognostic Study.

Long-term effects of proximal small bowel exclusion by duodenal-jejunal bypass liner on weight reduction and glycemic control in diabetic patients

BackgroundExclusion of the proximal gut from nutrient absorption entails significant metabolic benefits. The duodenal-jejunal bypass liner (DJBL) is the first endoscopic device that excludes the first part of the gut by covering it. ObjectivesTo assess weight and glycemic control at the end of treatment and after 1 year of follow-up. SettingBariatric endoscopy service in a tertiary medical center. MethodsDiabetic patients were treated with DJBL and followed prospectively between 2013 and 2016. Data were collected during scheduled visits. ResultsOut of 51 patients treated, 39 completed at least 9 months with the device. Complications were recorded for the entire cohort. Percent of total weight loss was 15.05% ± 6.0% after 12 months of treatment (P < .001 versus baseline). Twelve months postretrieval, percent of total weight loss decreased to 8.75% ± 5.07% (P < .001 versus baseline). Patients with baseline body mass index ≥35 kg/m2 experienced greater percent total weight loss changes over time (P < .001). There was a significant effect on hemoglobin A1C levels over time (P = .003), and the nadir was reached at 9 months of treatment (median 6.05% versus 7.20% at baseline, P < .001). Insulin users had consistently higher median hemoglobin A1C values compared with insulin nonusers (P < .001). Adverse events were experienced by 12 of 51 patients (23.5%), of which 4 cases (7.8%) were severe. ConclusionsProximal bowel bypass by DJBL is an effective tool for weight reduction and glycemic control. Metabolic achievements are partially preserved at 1 year after device removal. Because DJBL entails a considerable rate of side effects, strategies to mitigate them are warranted.

Caffeine and Glucose Metabolism at Rest Period, During, and Post Exercise in Diabetes Mellitus: A Systematic Review

Purpose: Diabetes Mellitus (DM) is correlated with a group of diseases related to the metabolism of glucose that is increasingly affecting the population, being considered a public health problem. Exercise increases absorption of glucose by the muscles during, pre- and post- periods of effort, therefore, it is an excellent treatment strategy to maintain the glycemic control of diabetic patients. Caffeine intake enhances Ca2+ concentration in β pancreatic cells, affecting insulin secretion. Materials and Methods: Systematic review with a sample of six scientific papers published in academic journals. Only studies involving soccer players (professionals and amateurs, except goalkeepers) were included in this review. Results and Conclusion: Studies included in this review concluded that caffeine might act in several ways in glucose metabolism; however, more researches are necessary to elucidate the real effects of this compound in the organism. Keywords: Diabetes mellitus, glucose control, glycemia, insulin, metabolism, pancreatic cells.

Hemoglobin A1c level in nondiabetic children with end-stage renal disease receiving regular hemodialysis

Objective This study was designed to assess hemoglobin A1c (HbA1c) levels in nondiabetic children with end-stage renal disease (ESRD) receiving regular hemodialysis (HD). Background HbA1c level represents an established tool to monitor glycemic control in diabetic patients. Patients and methods We enrolled 30 nondiabetic ESRD children receiving HD as a HD group and 30 healthy children as a control group for this study. All children were subjected to full history taking and physical examination. HbA1c, fasting blood glucose, hemoglobin level, hematocrit value, serum calcium, potassium, phosphate, blood urea nitrogen, creatinine, and parathormone hormone were measured in all participants. HbA1c level was measured by using the turbidimetric immunoassay method. Results We found a statistically significant difference as regards HbA1c (%) between cases and controls. In addition, there was no statistically significant difference in fasting blood glucose (mg/dl) between the two studied groups. Conclusion Our limited data indicate that HbA1c levels are elevated in nondiabetic ESRD patients receiving HD.

Influence of iron deficiency on Hb A1c levels in type 2 diabetic patients

AimsHemoglobin A1c (HbA1c) is gold-standard for the assessment of glycemic control in diabetic patients. Previous studies have reported that iron deficiency may elevate A1c concentrations, independent of glycemia. This study aimed to analyze the effect of iron status on HbA1c levels in diabetic patients. Methods661 patients 336 females (228 menopausal and 108 premenopausal) and 325 males (237 age> 50 years and 88 age < 50 years) were recruited.HbA1c, ferritin, fasting plasma glucose, hemogram and medical history were recorded.Analysis of variance ANOVA and Pearson’s regression were applied. Resultspatients were divided according gender, age, glycemia and iron status (normal, latent iron deficiency LID, iron deficiency anemia IDA).All groups presented increasing HbA1c values in parallel with iron deficiency, subclinical and anemia, but the level of significance was not homogeneous in the different groups.Controlled premenopausal women HbA1c in normal iron status and IDA groups P = 0.0048, between normal and LID, P = 0.033.Not controlled premenopausal women Normal group and IDAP < 0.001, normal iron status and LID P = 0.019.Controlled menopausal women normal group and IDAP < 0.0001, LID and IDA P = 0.01.Not controlled menopausal women normal group and IDA P = 0.04.Controlled men over 50 years normal and IDA groups P = 0.002, LID and IDA P = 0.02.Controlled young men normal group and LID P = 0.03. ConclusionThis study found a positive correlation between iron deficiency and increased HA1c levels. In diabetic patients with IDA should be interpreted with caution, due to the possibility of spurious increment in HbA1c.